HRA Rent Payment Self Declaration

Employee ID:
Employee Name
Rent Amount (per month).

This is to confirm that I would be paying rent per month of Rs.

() which is in total of months.

for the period Jan 2021 to March 2021 [Jan ’21,Feb ‘21 & March ‘21 ]

The proofs / original rent receipts would be submitted on request along with the copy of
the Self declaration to ABC

Date: 13-01-2021

Signature & Address :

Information Classification: General